West Michigan doctors deal with shortages of injectable pain medications
KALAMAZOO, Mich. —
The shortage of critical medications in hospitals across the country is forcing doctors to make difficult decisions when it comes to pain management for patients.
Injectable opiates, used to manage pain for serious injury, surgery, and terminally ill patients, are in short supply.
Oaklawn Hospital Executive Director of Medical Affairs Dr. Michael Chapman said, “We’ve had to think outside the box to get patients the care that they deserve,”
Chapman is also an attending physician in the emergency room of Oaklawn, which is in Marshall.
“It's been a difficult race to keep up with,” said Chapman.
Doctors have to think three steps ahead to know what to do when their first drug of choice is not available.
Chapman said, “Several times it's caused us to make decisions that we wouldn't otherwise.”
Like administering oral medications, which can take longer to take effect, or second, sometimes, third-choice drugs.
There are also ways to alleviate pain that don’t require pain medication alone, Dr. Chapman explained, “We’ve done nerve blocks where we’ve blocked the ability of a nerve to perceive pain and that’s been one thing, or using medications that are more of a dissociative where you can’t perceive pain.”
The shortage of medication commonly used in hospitals and hospices is a challenge and is “not getting better in the near future,” Chapman said.
According to Pfizer, its shortage of prefilled injectable opioid medications started in June 2017. The company’s manufacturing site in McPherson, Kansas, closed for prescheduled, annual maintenance and facility upgrades.
Then earlier in 2018, a third-party supplier raised concerns about an external piece of the prefilled syringe it had produced for Pfizer and the company put a hold on the shipments stockpiled for the planned shutdown at the McPherson plant.
We have been working closely with our supplier to remediate the root cause, and determine the impact on existing inventory and product supply moving forward.
In addition, we have been exploring the feasibility of increasing capacity within the global Pfizer manufacturing network and potential third-party suppliers.
Steve Danehy, Pfizer spokesman, said, “We have restarted production of our Carpuject™ prefilled syringes. The first shipments are expected to reach wholesalers in July 2018; and we will work to expedite the process where possible. We recognize the importance of these medications to patients and physicians and are committed to resolving these shortages as quickly as possible. We continue to work toward full recovery across the opioids product line in 1Q – 2Q 2019.”
At Oaklawn Hospital, Chapman said he saw the writing on the wall and stocked up on injectable morphine and Dilaudid, among other non-pain related medications before the shortage really started to hurt hospitals nationwide.
Along with manufacturing setbacks, Chapman said, government restrictions on production in an attempt to reduce opioid additions contributed to the shortage.
“We’ve been fortunate that we’ve had alternatives but it can impact patient care as far as first line treatment,” Chapman said.
Used to treat cancer patients, acute pain suffers, and traumatic injuries, Chapman said, injectable opiates are essential in hospitals.
Even fully stocked at Oaklawn, Chapman said he’s recommended lower doses or extending the amount of time between doses administered at the hospital in an effort to ration the injectable.
“We don’t want to get into a situation where a patient can’t have it but we want to make sure that we give it to them when they need it and in the amount they need,” Chapman said. “If it doesn't take care of the patients' needs I know I have that as a backup, I can give it.”
The spokesperson for Bronson Methodist Hospital says the region’s only level-one trauma center is successfully finding solutions so patients do not feel the impact of the nationwide drug shortage.
“We have a multi-disciplinary team which meets weekly to assess and plan for drug shortages. This team includes pharmacists, nurses and physicians,” said Carolyn Wyllie, Bronson spokesperson.
According to a written statement from the hospital, Bronson’s solutions include:
- Shifting supplies across our four-hospitals, as needed
- Finding alternative suppliers
- Finding comparable medications
- Buying in larger volumes, then repackaging into smaller sizes at Bronson pharmacies
Chapman explained why the single dose injectable are preferable to the larger volume containers.
“The pharmacist has to pull it up from a multi-dose vile, prepare that for each patient, check it, verify it, have somebody else verify it, send it up in a tube, have the nurse get that, then deliver it to the patient.” Chapman said, “There can be a time delay and that can reach the patient and it can make a patient suffer more than they need to.”
At Oaklawn, Chapman said the shortage has been more difficult for larger hospitals who have more patients coming in.
“Once you get behind in a shortage everyone else is behind, so everyone is competing for a limited resource which makes it even more difficult, so if I have Borgess competing and Bronson competing to get access to these medications, they are competing with everyone else in the country, so it’s very difficult to get that supply,” said Chapman.
The shortage of critical shortages stretches beyond pain medications, as of May 2018 the number of drugs on the shortage list topped 200.
A patient came into Oaklawn with an irregular heartbeat Wednesday and the doctor prescribed a secondary medication. Earlier this week it was a shortage of the IV form of medication to treat nausea and vomiting.
Chapman said, “When you only have one or two people making the medication, something goes wrong and all of the sudden we have no supply or we’re counting on other countries to get supplies who may not have the same standards that we have and that’s a risk that at our facility we don’t feel comfortable taking unless we absolutely have to.”